August 27, 2009
Clinical depression is a significant health problem in America; even by low estimates, it afflicts 6.7 percent of the general population in a typical year.
For military pilots, it can be a career-ender. Air Force pilots and navigators diagnosed with Major Depressive Disorder (MDD) are taken off flight status, and pilots on flying duty aren’t allowed to use common antidepressants like Zoloft and Prozac, even when effective, for fear of possible side-effects.
That policy may change, however. Canada already allows some military pilots to use antidepressants if their depression is in remission, as does Australia (which has seen no attendant drop in safety). The U.S. Federal Aviation Administration is considering whether private pilots should be allowed to fly while taking antidepressants. Should the Air Force follow suit?
Before deciding, it might be useful to know how common depression is among military pilots and navigators. So Blake Lollis and his colleagues at the Air Force School of Aerospace Medicine in San Antonio, Texas, took a look at the data. Their results, published in the August issue of Aviation, Space, and Environmental Medicine, suggest that military aviators are a pretty happy bunch. After searching through electronic medical records for Air Force pilots and navigators (who numbered about 18,000 during the study period), the researchers found just 51 reported cases of major depression, 43 of which were non-recurring, over a five-year period. The annual prevalance of major depression among pilots and navigators was just 0.056%, far lower than the rate in the general population, and lower than the 2.8% rate for civilian executives and administrators.
Why? Lollis and his colleagues allow that some cases of depression may go undetected or misdiagnosed. Some pilots may practice “reverse malingering,” faking their test results to stay on flight status (some aviators have been known to memorize eye charts to get around vision requirements). It may be that pilots just don’t report their depression to Air Force doctors, and seek help on the sly.
But it’s also likely, write the authors, that “the mental ‘make-up’ or status of USAF pilots and navigators is significantly different from that of the U.S. general population.” For one thing, they’re all college graduates, with an average IQ of 124 (vs. 98 for the general population). They’ve had to “successfully overcome physical, behavioral, emotional, and academic hurdles.” Pilots work in a field that demands focus and self-confidence, and people with personality disorders are selected out. Surveys also show that successful military pilots have “exceptional consistency of background and better than average social and socioeconomic conditions when growing up.”
Considering these and other factors, the authors conclude, “it is highly likely that [military pilots] are a special population who…are less prone to psychiatric illness, including [depression] than the general population.”